Pancreatic tuberculosis masquerading as pancreatic serous cystadenoma

Figure 1 Abdominal US and CT at admission. A: Abdominal US revealed an irregularly contoured, hypoechoic, cystic lesion in the head of the pancreas, with calcification at the center of the mass (arrow); B: abdominal CT demonstrated an inhomogeneous lobulated multicystic mass of 4.5 cm × 2.0 cm in the head and uncinate process of the pancreas, with central calcification (arrow).

Figure 2 MRI of the pancreatic mass. A and B: Gadolinium-enhanced T-1 weighted image of the sharply delineated multiloculated mass in the pancreas head, with peripheral and central areas of enhancement; C: T-2 weighted image of the heterogeneous mass with increased and decreased signal intensities.

Figure 3 EUS and ERCP findings. A: Lobulated multicystic lesion of heterogeneous echotexture and focal calcification (arrow); B: endoscopic view of the normal appearance of the ampulla with no mucus secretion from its orifice; C: fluoroscopic view of no communication between the pancreatic duct and the cystic mass.

Figure 4 Histological image of resected specimen. A: Photograph showing the epithelioid granuloma with central caseous necrosis (HE, original magnification, × 100); B: multinucleated Langhans’ giant cell with surrounding lymphocytes (arrow) (HE, original magnification, × 400).